Heart failure affects 5 million Americans, and 75% of cases have antecedent hypertension that can be managed by adherence to medication regimens and monitoring of blood pressure and weight. The long-term objective of this research is to improve healthful behaviors, including adherence to medication and treatment regimens, of patients living with heart failure by implementing individualized home telemonitoring feedback. The specific aims are to 1) validate cognitive themes of patient reactions to telemonitoring, 2) examine and compare effects of patient characteristics and differential feedback on patient reactions to telemonitoring and 3) examine and compare effects of patient characteristics and differential feedback on patient reactions to telemonitoring and behaviors. This proposed project builds on quality-outcomes research that attests the promise of remote home health care as a method that involves patients and reduces hospital visits and length of stay. The outcomes have prompted an unprecedented growth in telemonitoring for post-hospitalized, chronically ill patients. Patients and nurses are satisfied with the mechanics of telemonitoring and comply with daily use, but behavioral adherence to regimens varies across studies. Face-to-face feedback between nurses and patients can have a powerful, positive influence on behaviors, but it is unknown how feedback using telemonitoring, in which a nurse is remotely monitoring the patient's vital signs, affects how a patient behaves and cognitively reacts to his or her treatment regimen. The research will be conducted in two phases. Phase I is a qualitative thematic analysis of patient reactions to telemonitoring. Results from Phase I will inform Phase II measurements. Phase II is a quantitative comparative analysis of the effects of patients'characteristics and the differences in remote feedback on their reactions to telemonitoring and their behaviors. Growth models with repeated measure ANOVAs and multiple regressions will examine effects and predictability of independent variables on outcomes. An interdisciplinary team of researchers will evaluate and interpret results for application to future research on technological feedback that supports an individual's motivation to adhere to beneficial behaviors. PUBLIC HEALTH RELEVANCE: Heart failure is the leading cause of hospitalization for Medicare patients, yet much of the care following heart failure can and does take place at home. Telemedicine has shown great promise in helping patients, families, and nurses as they take on important roles in home care. This research examines best practices for individualized home telemonitoring for patients to improve their adherence to treatment and cultivate behaviors that will lead to a better quality of life within the constraints of insurance-reimbursement plans.